Month: November 2018

The Plan C is a very popular Medigap plan. It provides all the benefits and coverage of the Plan F with the exception of not covering the excess charges under the Original Medicare Part B. The key features and benefits of the Medicare Supplement Plan C and its suitability to the customers are provided below:

Features of Plan C

The Plan C covers the entire cost pertaining to the Medicare Part A coinsurance. It covers the Medicare Part B coinsurance and copayments. The customers are also covered for up to the first three pints of blood for medical procedures. The customers are provided 100% coverage pertaining to Part A hospice care coinsurance and copayments. It covers the coinsurance for medical care provided by the skilled nursing facility (NCF). The Plan L of the Medicare Supplement plan covers 100% of the Medicare Part A deductible. Plan C along with the Plan F is the only plan to cover the deductible for Medicare Part B. The 2019 Medicare Supplement Plan C also provides coverage against international healthcare expenses. It covers the customers during overseas travel and provides 80% of the total emergency healthcare expenses when the customer travels to foreign country. The customers need to pay a deductible of $250 before availing the benefits of international emergency healthcare expenses.

Exclusions

The Medicare Supplement plan C does not cover the Original Medicare Part B excess expenses. The Medicare has fixed rates for different Medicare-approved services. If a doctor does not accept Medicare Assignment, then as per law, he/she can charge a maximum excess of 15% over the Medicare-approved rates. The policyholders of the Medicare Supplement Plan C have to pay the excess Part B expenses as out-of-pocket expenses.

Is it Suitable for Customers?

The Plan C is the most popular Medicare Supplement plan in the United States after the overwhelming favorite Plan F. In the year 2014, 10% of the total Medicare Supplement plan sales consisted of Plan C. It is one of the most comprehensive Medicare Supplement plans providing complete coverage against copayments, coinsurance, and deductibles. The Plan C is suitable for customers who would be needing intensive and frequent medical care. The Plan C provides peace of mind to the customers and they do not need to worry on any out-of-pocket expenses except for the Part B excess charges. The Plan C monthly premiums are on the higher side, but if the customers can afford it, then they can definitely opt for Plan C which will provide them comprehensive coverage.

Plan L of the Medicare Advantage plan is a cost-sharing plan, which means that the benefits are not fully covered. It covers 75% of most of the out-of-pocket expenses and the remaining 25% has to be paid by the policyholder themselves. The cost-sharing under the Plan L is considerably higher than most other plans, meaning the customers of the Plan L will have to bear greater out-of-pocket expenses. Since the cost-sharing is higher, the Plan L has a lower monthly premium than other Medicare Advantage plans. The details of the features and benefits of the Plan L and its suitability for customers are provided below:

Features of Plan L

The Plan L covers the entire cost pertaining to the Medicare Part A coinsurance. It covers the Medicare Part B coinsurance and copayments. The Medicare Part B pays for 80% of the Medicare-approved amount for the covered services. The Plan L being a cost-sharing plan covers 75% of the remaining 20% Part B copayment. The customers are also covered for up to the first three pints of blood for medical procedures. It provides coverage of 75% related to the Part A hospice care coinsurance and copayment and 75% of the coinsurance for medical care provided by the skilled nursing facility (NCF). The Plan L of the Medicare Advantage plan covers 75% of the Medicare Part A deductible. It, however, does not cover the deductible for Medicare Part B.

Out-of-Pocket Limit

The Medicare Advantage Plan L has a yearly out-of-pocket limit. This means that as the customers hit this out-of-pocket limit, they are provided 100% coverage of the benefits and they not need to pay any additional benefits. The out-of-pocket limit for the year 2018 is $2,620, provided the medical expenses are for Medicare-covered services. This out-of-pocket limit is inclusive of the deductible for Original Medicare Part B ($183 for the year 2018). Once the customers reach their out-of-pocket limit, then the Plan L pays 100% of the Original Medicare costs that it is required to cover for the remainder of the year.

Is it Suitable for Customers?

Plan L is not a popular Medicare Advantage plan in the United States. As per the data of 2014, only 16% of the total insurance carriers sold the Plan L and a mere 0.5% of the total Medigap policies sold in 2014 consisted of Plan L. It is a basic health coverage plan with modest monthly premiums. It can be suitable for customers wanting an affordable plan with basic health coverage and who are fine with the annual out-of-

Plan K of the 2019 Medicare Supplement plan provides basic healthcare coverage at a reasonable monthly premium to the customers. With the exception of the Medicare Part A coinsurance and hospital costs for a year, it covers 50% of the other expenses. The Plan K has a high out-of-pocket expense for the customers, thus it has a low monthly premium. Some of the key features and benefits of the Plan K of the Medigap are provided below:

Features of Plan K

The Plan K covers the unmet expenses of Original Medicare Part A and Part B. It provides basic health coverage at an affordable monthly premium. The Plan provides partial health coverage by providing 50% of many Original Medicare deductibles and copayments. The Plan K covers all the Medicare-approved Part A coinsurance and costs up to 365 days after the Medicare benefits are exhausted. It covers 50% of the total expenses towards- Medicare Part B coinsurance and copayments, the first three pints of blood for medical procedures, skilled nursing facility (SNF) coinsurance, and Medicare Part A deductible, and Medicare Part A hospice care coinsurance or copayment.

Out-of-Pocket Limit

The Medicare Supplement Plan K and Plan L are the two plans which includes an annual out-of-pocket limit. Under the Plan K, the yearly out-of-pocket limit is $5,240 in the year 2018. This out-of-pocket limit includes the deductible for the Original Medicare Part B. Once the customers have reached their out-of-pocket limit for the year, then the Plan K will provide 100% coverage towards the Medicare-covered costs. It is important to note that the annual out-of-pocket limit for the Plan K is about twice the amount for the Plan L.

Is it Suitable for Customers?

Plan K is not a very popular plan among the customers. According to the year 2014 data, 16% of the Medigap insurers offered the Plan K and only 1% of the total Medigap policyholders purchased this plan. The yearly out-of-pocket expenses is useful if the customers want to be protected against high out-of-pocket costs due to chronic health conditions which require ongoing medical care or to meet any unexpected medical emergency. If the customers want a plan with lower annual out-of-pocket limit after which they will be covered by the plan benefits, then they can choose Plan L which has about half the out-of-pocket limit. If the customers have a high medical expenses and they would prefer higher coverage then they can opt for other Medicare Supplement plans providing more comprehensive coverage.